Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly patients: A prospective, systematic study with specific focus on postoperative dislocation using posterior approach.

Abstract

Introduction: Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation.Hypothesis: Dual mobility cups have a low dislocation rate when used to manage fractures of the femoral neck with posterior approach.Patients and methods: In our center prospective study conducted in Amritsar (Punjab) India over an inclusion time of 2 years, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup with posterior approach. Patients had clinical and radiological assessment at immediate post op, 3 and 6 months, 1 year and 3 year after surgery.Results: Among these 240 patients, The right hip was operated on 121 (50.4%) patients and left hip on 119 (49.6%) patients. There was a male preponderance seen and 101 (42.1%) out of 240 patients were female. None of the patients was lost to follow-up. All patients were operated through a posterior approach. The mean Harris hip score improved from 16.62 ± 6.34 preoperative to 92.86 ± 2.28 at the time of 1 year follow up and 95.20 ± 1.82 at the time of 3 years follow up We had three dislocation occurred and Open Reduction was performed through posterior approach under regional anesthesia for 2 patients and close reduction done in one patient . There was no recurrence of dislocation.CONCLUSIONS: Our experience with Dual mobility cup is an effective solution for the management of treatment for displaced fracture of the femoral neck in the elderly undergoing total hip replacement to reduce the incidence of postoperative instability even after using posterior approach.